Provider Demographics
NPI:1649719956
Name:SMR MEDICAL CORP
Entity type:Organization
Organization Name:SMR MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKHRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-416-9351
Mailing Address - Street 1:2262 SE WALD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-4739
Mailing Address - Country:US
Mailing Address - Phone:844-416-9351
Mailing Address - Fax:844-410-4490
Practice Address - Street 1:10024 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5625
Practice Address - Country:US
Practice Address - Phone:844-416-9351
Practice Address - Fax:844-410-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier